Factors associated with non-intervention of antifibrotic agents in IPF patients

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation Pub Date : 2024-10-02 DOI:10.1016/j.resinv.2024.09.008

Maki Asami-Noyama , Kazuki Hamada , Yoshiyuki Asai , Takeshi Abe , Kosei Yonezawa , Michiya Watanabe , Yukari Hisamoto , Keita Murakawa , Ayumi Fukatsu , Kazuki Matsuda , Shuichiro Ohata , Ryo Suetake , Yoriyuki Murata , Yoshikazu Yamaji , Keiji Oishi , Nobutaka Edakuni , Tsunahiko Hirano , Tomoyuki Kakugawa , Kazuto Matsunaga

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引用次数: 0

Abstract

Background

The efficacy of antifibrotic agents in idiopathic pulmonary fibrosis (IPF) has been demonstrated and early introduction is recommended, especially in patients with preserved performance status (PS). We aimed to determine the proportion of untreated IPF cases using real-world data and to assess the factors associated with non-intervention.

Methods

A prospective observational study using questionnaires was performed on 518 patients with interstitial lung disease (ILD) and their attending physicians who visited a clinic, general hospital, or tertiary respiratory center between December 2019 and October 2020. Patients responded with subjective symptoms and PS, whereas physicians responded with diagnosis, treatment, and reasons for their treatment choices. Principal component analysis (PCA) was performed using age, sex, BMI, medical facility, specialized tests, and symptom severity.

Results

We included 207 patients with IPF. Among them, 168 has a good PS (≤2), which could be indicative of treatment; 130 (77.4%) were not treated with antifibrotic agents. The PCA revealed a trend consistent with that of antifibrotic agent therapy and the distribution of medical facilities, with a treatment intervention rate of 16% in general hospitals and 62% in tertiary respiratory centers. In general hospitals, low symptom severity (PS, mMRC, and no use of long-term oxygen therapy) was a relevant factor for non-intervention with antifibrotic agents (p < 0.001).

Conclusion

Antifibrotic treatment interventions varied by facility in cases with good PS. Patients with milder symptoms are not being treated early in general hospitals and more collaboration between general hospitals and specialized facilities is necessary.

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IPF 患者不使用抗纤维化药物的相关因素。

背景：抗纤维化药物对特发性肺纤维化（IPF）的疗效已得到证实，建议尽早使用，尤其是对表现状态（PS）保持良好的患者。我们旨在利用真实世界的数据确定未经治疗的 IPF 病例比例，并评估与不干预相关的因素：2019年12月至2020年10月期间，我们对在诊所、综合医院或三级呼吸中心就诊的518名间质性肺病（ILD）患者及其主治医生进行了一项前瞻性观察研究，采用问卷调查的方式。患者回答了主观症状和 PS，而医生则回答了诊断、治疗和选择治疗的原因。利用年龄、性别、体重指数、医疗机构、专业检查和症状严重程度进行了主成分分析（PCA）：我们共纳入了 207 名 IPF 患者。其中，168 名患者的 PS 值良好（≤2），这可能是治疗的指标；130 名患者（77.4%）未接受抗纤维化药物治疗。PCA显示的趋势与抗纤维化药物治疗和医疗机构分布一致，综合医院的治疗干预率为16%，三级呼吸中心为62%。在综合医院，症状严重程度低（PS、mMRC 和未使用长期氧疗）是不干预抗纤维化药物治疗的一个相关因素（P 结论：在综合医院和三级呼吸中心，抗纤维化药物治疗干预率分别为 16%和 62%：在 PS 良好的病例中，抗纤维化治疗干预因医疗机构而异。综合医院没有对症状较轻的患者进行早期治疗，因此综合医院和专科医院之间有必要加强合作。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Respiratory investigation RESPIRATORY SYSTEM-

CiteScore

4.90

自引率

6.50%

发文量

114

审稿时长

64 days